EUS-Guided Pancreatic Duct Drainage: On which patients, how to perform it? Is it as complicated as thought?

Aims EUS-guided pancreatic duct drainage (EUS-PDD) is one of the most technically challenging procedure for endoscopists. The most common indications include pancreatic duct strictures, stones, and altered anatomy due to surgery. There are two generally accepted methods for EUS-PDD: the first involves performing retrograde pancreatography following EUS-guided antegrade access, and the second is direct transmural drainage using EUS-guided techniques. This study aims to evaluate patients requiring EUS-PDD, the indications and types of procedures performed, and the success and complication rates.

Methods We reviewed 8 patients data who underwent EUS-PDD between 2020 and 2024 due to various reasons making retrograde pancreatography impossible.

Results A total of 22 procedures were performed on 8 patients, all of whom were male. The median age was 58.5 years (range, 21-75 years). Seven patients had pancreatic duct stones that would not allow retrograde cannulation, 6 patients had simultaneous chronic pancreatitis findings, and four had simultaneous pancreatic duct stricture, and the remaining one patient had a malignant lesion. In our series, one patient received only a plastic stent, one received a metal stent, and the remaining 6 patients had drainage with a combination of plastic and metal stents in subsequent procedures. Three patients underwent dual procedures (EUS-PDD+ERCP) in follow-up sessions, two patients received spyglass-assisted laser lithotripsy following EUS-PDD with an appropriate fistula created, two patients were referred to extracorporeal shock wave lithotripsy for pancreatic duct stones after EUS-PDD, and one patient underwent PDD only. Our technical success rate for EUS-PDD was 100%, and the clinical success rate was 82%. There were no serious complication such as perforation or mortality; however, five of the 8 patients experienced symptoms such as pain and transient fever after the procedures.

Conclusions EUS-PDD is crucial for accessing the pancreatic duct in cases of strictures or alterad anatomies that cannot be managed via retrograde approches. Although technically challenging one among the interventional endoscopic procedures, it does not have as high a complication rate as might be thought. In this context, when performed by experienced endoscopists, it has a high safety profile.

Publication History

Article published online:
27 March 2025